Child Health  |  UTI Pathway - Further Investigation




Child Health

UTI Pathway - Further Investigation


Investigations depend on the age of the child, the severity of infection and past history. There is an international move towards a less invasive approach.

Ultrasound (US): Paediatric renal USS is available by direct GP referral to the Radiology department.

Acute US is indicated for:

  • Children admitted with atypical UTI*
  • Infants admitted under 3 months old.
  • Children admitted and not responding to treatment within 48 hours.

Outpatient US within 6 weeks (unless done as an inpatient):

  • Children under 12 months old with first febrile UTI.
  • All children with:
    • Severe illness
    • Recurrent febrile UTI
    • Atypical history.

Follow-Up US one year later:

  • Children with parenchymal abnormalities seen on initial US should have a follow-up on year later.
  • If abnormalities persist then nuclear medicine imaging should be considered.


* Atypical UTI

  • UTI associated with sepsis or bacteremia.
  • Concern regarding obstructive uropathy.
  • Failure to respond to antibiotics within 48 hours.
  • Associated impaired renal function.
  • Infection with non-E.coli organisms.



Micturating Cystourethrogram (MCUG)

There is no evidence of benefit from detecting vesico-ureteric reflux (VUR) for the majority of children and for this reason MCU is no longer a routine recommendation. The request for an MCU should come from within hospital only.


MCU should be considered for:

  • Infants under 3 months with US abnormalities after their first febrile UTI and / or atypical UTI.
  • For children under 6 months with recurrent febrile UTI and /or abnormal US.
  • For male infants where there is concern regarding obstructive uropathy on US.


A cystogram involves inserting a fine catheter into the child's bladder, filling the bladder with radiographic contrast, and taking sequential x-ray images. This is usually done under a light general anaesthetic, to reduce the stress to child and parent. In infants less than 3 months of age a cystogram is done under local anaesthetic only. The procedure usually takes less than 5 minutes. After recovery, the child is free to go home. Often the procedure is covered with oral antibiotics.


DMSA/DTPA scanning

Nuclear medicine imaging is the most sensitive means of detecting renal parenchymal abnormalities. This investigation is performed in Hamilton.

Indications for DMSA scanning include:

  • Asymmetry in renal size.
  • Abnormal renal size for age.
  • Suspicion of a parenchymal defect or scarring on US.


Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018


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